She suffered from Sjogren syndrome and inflammatory arthritis and was currently treated with prednisone and methotrexate. She was previously treated with hydroxychloroquine (Plaquenil) 200mg bid (6.5mg/kg) for 10 years, which was stopped one year prior to presentation. Chloroquine mechanism of drug action and resistance in plasmodium falciparum Chloroquin function in lysosome Dec 27 2013 by David Callanan, MD 59yr old patient. Had several courses of chloroquine for malaria; native of Africa. Condition/keywords bull's eye maculopathy, chloroquine A daily dose of chloroquine 3 mg/kg and a treatment duration of 5 years are considered important risk factors for the development of retinopathy. Therefore, patients who are taking chloroquine or hydroxychloroquine should have regular ophthalmic examinations to detect retinal changes as early as possible in order to minimize retinal toxicity. Forty-seven year-old male patient with medical history of psoriatic arthritis treated with chloroquine. Visual acuity was of counting fingers. Color fundus photos showing bull's-eye maculopathy and optic nerve atrophy associated with chloroquine toxicity. Review of systems: Blurred vision, halos, dry eye, dry mouth, gastroesophageal reflux, joint pain Pupils: Reactive to light in each eye from 5 mm in the dark to 2 mm in the light. Extraocular movements: Full, both eyes (OU) Confrontation visual fields: Full OU Intra-ocular pressure The optic nerves appeared healthy with a 0.3 cup-to-disc ratio. Past Ocular History: None Medical History: Sjogren syndrome and inflammatory arthritis, supraventricular tachycardia, anxiety, depression, peptic ulcer disease Medications: prednisone, methotrexate, amitriptyline, ranitidine, estradiol, tizanidine, diltiazem, Restasis Allergies: codeine, droperidol Family History: heart disease, arthritis, cancer Social History: occasional alcohol but no tobacco or intravenous drug use. Chloroquine bull's eye maculopathy guidelines Hydroxychloroquine And Chloroquine Screening 2016 AAO., Retinal Damage in Chloroquine Maculopathy, Revealed by. Hydroxychloroquine pkaPlaquenil 200mg pret Apr 20, 2011 Toxic maculopathy associated with chloroquine use was first documented in the literature five decades ago.1 In the United States, Plaquenil––an analog to chloroquine––is used to treat a variety of conditions, including rheumatoid arthritis, lupus and several distinct inflammatory disorders. New Plaquenil Guidelines -. Bull's-eye maculopathy - American Academy of Ophthalmology. Early Plaquenil Toxicity Detected without Bull’s Eye Maculopathy. Jan 05, 2020 Its toxic effects on the retina are seen in the macula. While early toxicity may be asymtomatic, patients with more advanced stage of toxicity may complain of color vision changes or paracentral scotomas. Advanced hydroxychloroquine toxicity presents as a bullseye maculopathy. And before treatment is initiated with hydroxychloroquine, a complete ophthalmic examination should be performed to determine any baseline maculopathy. Ophthalmologists should also follow the most current screening guidelines established by the Academy, 1 recently revised in light of new findings. Symptoms and Signs. Symptoms. Later in the disease, patients can develop a bilateral bull's eye maculopathy, characterized by a ring of retinal pigment epithelium RPE depigmentation in the macula, sparing the fovea, which is often accompanied by paracentral and central scotomas. End stage hydroxychloroquine toxicity leads to widespread RPE and retinal atrophy with a loss of central vision, peripheral vision, and night vision.